Cellulitis

NURSING CARE

1. CELLULITIS ALBERT BLESSON V

2. CELLULITIS An infection of the dermis or subcutaneous layer of the skin, cellulitis may follow damage to the skin, such as with a bite or a wound. If treated in a timely manner, the prognosis is usually good. If the cellulitis spreads, however, fever, erythema, and lymphangitis may occur, particularly in patients with other contributing health factors, such as diabetes, immunodeficiency, impaired circulation, or neuropathy

3. Cellulitis spreads rapidly all over the body, yet cannot spread from one person to another. Cellulitis is a common, potentially serious bacterial skin  infection . It indicates a non-necrotizing inflammation of the skin and subcutaneous tissues derived from acute infection. Cellulitis may appear as a swollen, red area of skin that feels hot and tender.

4. Causes Certain factors can increase the risk of developing cellulitis and these are: Weak immune system. Bacteria easily lodges to a person who has a weak immune system. Breaks in the skin. Eczema and athlete’s foot, for example, causes breaks in the skin wherein bacteria can enter and cause cellulitis. Intravenous drug use. The insertion site is also a break in the skin that could become the entry point of pathogens. Diabetes. Patients with diabetes experience slow wound healing, and long exposure of wounds could cause infection from pathogens.

5. Pathophysiology Cellulitis mostly arise from breaks in the skin that are not covered or cleaned well. Weak defense. Cellulitis usually follows a break in the skin like puncture wounds, fissures, or lacerations. Entry. Organisms in the skin gain entrance to the dermis and multiply to cause cellulitis. Inflammation. The infected skin would get swollen, red, and tender, and fever may accompany these symptoms. Invasion. If cellulitis is left untreated, the infection could reach the inner layers of the skin and enter the lymph nodes and bloodstream and spread throughout the body.

6. Phases of Acute Inflammatory Response PICTURING PATHO The following illustrations show the phases of acute inflammatory responses in cellulitis

7. Signs and Symptoms Erythema and edema Pain at the site and, possibly, the surrounding area Fever and warmth

8. Treatment Antibiotics, either p.o. or IV, for the causative organism, depending on the severity Pain medication (e.g., acetaminophen or ibuprofen), as needed, to promote comfort Elevation of the affected extremity above heart level to promote comfort and decrease edema Modified bed

9. Medical Management The management of cellulitis focuses mainly in the eradication of the infection. Antibiotic therapy. Antibiotics are effective in more than 90% of the patients and treatment may last from 10 to 21 days, depending on the severity of the condition. Drainage. Abscess need drainage for resolution whatever the pathogen is. Analgesics. Pain relievers are prescribed in some cases. Rest. Rest is necessary until symptoms improve, and while resting, affected area should be raised higher than the heart to reduce swelling. Surgical Management When the tissue affected by cellulitis has reached the worst condition, surgical arrangements may be necessary. Amputation. Amputation would only be required if the affected area becomes gangrenous or necrotic.

10. NURSING DIAGNOSIS According to the baseline data gathered, the following diagnoses are achieved: Impaired skin integrity related to altered primary defenses. Disturbed sensory perception related to impaired nerve stimulation. Risk for situational low self esteem related to disturbed body image.

11. Nursing Interventions The care for a patient with cellulitis mainly rests on the antibiotic regimen. Secure specimen. Obtain specimen from draining wounds as indicated to determine appropriate therapy. Monitor complications. Observe for complications to monitor progress of wound healing. Clean the area. Keep the area clean and dry and carefully dress wounds to assist body’s natural process of repair. Wound care. Use appropriate barrier dressings and wound covering to protect the wound and surrounding tissues.

12. Nursing Considerations Assess the patient for an increase in size of the affected area or worsening pain. Administer an antibiotic and an analgesic, and elevate the extremity as ordered. TIP: Cellulitis can be life threatening depending on the causative agent

13. Recognizing Cellulitis The classic signs of cellulitis are erythema and edema surrounding the initial wound. The tissue is warm to the touch

14. Assessment and Diagnostic Findings Determining the extent of cellulitis is important so that the treatment would be appropriate. Blood tests. The physician may order a blood test to rule out systemic or blood infection. Wound culture. A wound culture would be performed to determine the causative factor of the infection. Ultrasound. Ultrasound may play a role in the detection of the abscess and how to treat it.

15. Prevention Preventing cellulitis is more favorable than trying to treat one. Here are some tips on how to prevent cellulitis from occurring. Clean thoroughly. Clean the break in your skin immediately and apply antibiotic ointment aseptically. Covering. Cover the wound with a clean bandage and change it regularly until a scab forms. Observe. Watch the affected site for signs of wound infection such as tenderness, discharges, and pain.

16. COMPLICATION Cellulitis, if left untreated, could result in more severe complications such as the following. Blood infection. The blood could become contaminated because of the pathogens that enter the blood stream and affect the surrounding tissues. Bone infection. The infection may burrow through the layers of the skin and reach the bones. An inflammation of lymph vessels. When there is infection, the lymph nodes may become inflamed and infected as well. Gangrene. The worst case scenario in cellulitis is if it develops to be gangrene because of the lack of oxygen in the tissues.

17. Teaching About Cellulitis Emphasize the importance of complying with treatment to prevent relapse. Instruct the patient to use a properly cleaned shower instead of the bathtub until the skin problem has healed to prevent worsening of the infection. To prevent recurring cellulitis, teach the patient to maintain good general hygiene and to carefully clean abrasions and cuts. Urge early treatment to prevent the spread of infection. Describe the importance of range-of-motion exercises to prevent deep vein thrombosis.

18. REFERENCE LippincottVISUAL NURSING A Guide to Diseases, Skills, and Treatments Third Edition